Mutuelle de Santé is on course to meet its objective

The contribution of Mutuelle de-Sante in improving the health care of our population needs no emphasis.  Mutuelle has become a household brand that every Rwandan of today regards as a basic necessity of life just like shelter, food and water.
Andrew Makaka
Andrew Makaka

The contribution of Mutuelle de-Sante in improving the health care of our population needs no emphasis.  Mutuelle has become a household brand that every Rwandan of today regards as a basic necessity of life just like shelter, food and water.

Building this programme to this level has not been a simple feat. It has taken some strategic policy shifts designed to bridge any gaps but also taking stock of the changing dynamics on the ground.

At times, such shifts might raise eyebrows but ultimately the desired goal is an overall improvement of systems, which remains the focus until it’s achieved.

The New Times’ editorial published yesterday (Tuesday 26) that followed an article published on Monday under the headline “Lawmakers push for Mutuelle autonomy,’ brought out some inaccuracies that are partly linked to the above changes.

Therefore, in my capacity as the person overseeing Mutuelle de-Sante within the health sector, I wish to make a few clarifications for the common good of this programme.

Mutuelle and arrears

It is true that due to the low premium rates in the earlier mutuelle policy (Rwf1000 per head), there were some financial constraints to the scheme, which ultimately led to some debts owed to some health facilities.

However, as a direct solution to this problem, government designed a new policy guided by extensive studies that showed increased capacity of Rwandans to pay a higher premium.  This new policy, introduced in 2011, established that members of Mutuelle would be stratified in three categories, based on the Ubudehe stratification mechanism.

Under the new policy, categories are now required to pay different premium levels, a move that has substantially increased the amount of revenues collected by Mutuelle de Sante’. As a result, in the fiscal year 2011/12 Mutuelle de Sante’ has been able to pay all hospital bills, a sign that with the new policy Mutuelle is moving towards financial sustainability and financial robustness.

The debts accumulated during the old policy will still be recovered guided by the recommendation from last year’s Government retreat.

Creation of a Mutuelle-de-sante entity

The current emphasis on making Mutuelle de Sante’ an autonomous agency is not a sudden change resulting from any structural weaknesses of this programme. It is simply the application of the Law n° 62/2007 of 30/12/2007. The management and implementation of a large financial scheme such as Mutuelle, which is the largest health insurance scheme in the country, is not a responsibility of the Ministry of Health. The role of the Ministry of Health has been to incubate the scheme until it reaches financial robustness and is ready to be transferred to a new structure that can be easily regulated by BNR and that can implement strong financial management tool i.e. advanced IT software, financial management software, meeting reporting requirements as well as operational standards.

Once autonomous from the Ministry of Health, Mutuelle will however remain strongly embedded within communities to keep the strong community-ownership aspect that characterizes the Mutuelle scheme in Rwanda.

Quality of Service in the hospitals

It is important to note that the debts accumulated by Mutuelle during the old policy are by no means an excuse for poor quality of services in the hospitals.

All public hospitals receive an annual budget to cover their running costs.  Medical equipment is purchased directly by the Government, which is also responsible to pay staff salaries. To encourage motivation, hospital staff benefit from performance-based financing, which is paid by the Government with the support of development partners. Whenever hospitals have faced high debts, the Ministry of Health has always intervened to clear the debts and ensure no stock-out occurred (through RBC/MPDD, ex-CAMERWA). All drugs are purchased on an accrual-basis.

With these systems in place the accumulation of debts by Mutuelle cannot be an excuse to provide poor quality service because Hospitals and hospital staff are accorded the condition to function properly.

Finally, like I mentioned earlier, Mutuelle de Sante is important for the development of our nation. Its contribution towards driving forward our development agenda has been documented and over-emphasised. It is, therefore, a collective responsibility of every Rwandan to contribute in tightening any loose nuts and ensure that the self-sustainability we desire for this programme is attained.

Figures from 2011-2012 financial year show that we are on the right path.  In addition, we urge the population to always point out any cases of poor service delivery because access to good services is within their rights.

The writer is Director Health Financing, MoH.

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